An “Info Card” about our support group and information resources A booklet: A Patient’s Guide to Thyroid Cancer: for those diagnosed with Papillary or Follicular Cancers Thyroid Cancer Canada’s Low Iodine Diet Recipes 416 487 0601 Toronto, ON M5N 3A8 550 Eglinton Ave. W. PO Box 23007 Thyroid Cancer Canada fax: voice: 416 487 8267 [email protected] The Thyroid Canada website contains our quarterly newsletter, new patient resources, and updates on topics of interest to Canadian thyroid cancer patients and medical specialists. Please visit the website regularly to learn more about TCC projects and events. If you would like to be added to our mailing list please contact us at: • • • Also available from Thyroid Cancer Canada: For serving-size information see Canada’s Food Guide at http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php www.thyroidcancercanada.org Scientific and medical references available on Thyroid Cancer Canada website This publication has been written using techniques of clear language and design. Version 6 – Aug 2013 A short-term diet to prepare for radioactive iodine treatment or scan Low Iodine Diet www.thyroidcancercanada.org Thyroid Cancer Canada No. Salt is also called sodium chloride. You need to avoid iodized salt and sea salt because they contain iodine, not because they contain sodium. You can still have foods with sodium if they are low in iodine. Is a LID the same as a low sodium diet? A low iodine diet starves the body of iodine. Thyroid cells will crave iodine more than others. When RAI is given, thyroid cells take up the radiated iodine, which makes them able to be seen in the scan. When given at treatment levels, RAI destroys thyroid cells including those that are cancerous. How does a LID help with RAI treatment or scanning? You will be asked to follow a LID for 14 days before your RAI treatment or scan and for about 2 days after your treatment or scan. Then, you can go back to eating as usual. Your doctor or dietitian will tell you the exact schedule. adding iodine • choose foods and drinks low in iodine • prepare foods and drinks without To lower iodine in your diet: In a LID, the total amount of iodine you take in each day should be less than 50 micrograms (mcg). This will be much less than you are used to having. For example, the amount of iodine allowed on this diet in a day is equal to the amount found in less than 1/8 teaspoon of iodized table salt. Look for recipes in low-iodine cookbooks and on-line at www.thyroidcancercanada.org Be sure to use Canadian recipes. Make home-made foods “from scratch” and have fruits and unsalted vegetables on hand. Add flavour with fresh or dried herbs, salt-free spice mixes or vinegars. Hide or move your salt shaker so that you won’t be tempted to use it. We suggest you plan ahead and prepare meals in advance, especially if you will be hypothyroid while on the diet. How can I prepare foods without iodine? There may be times when you are not sure if a food contains iodine. If you are in doubt, leave it out! Avoid foods that list salt or sea salt. Salt is used in most canned foods, take-out and restaurant foods, and pre-packaged foods. It is important to avoid them. All table salt packaged in Canada has iodine; however some table salt from the United States may be iodine-free (check the label). Do not eat foods and drinks that contain high levels of iodine. High iodine ingredients to AVOID are listed in the chart on the next page. Before you purchase a product, check the ingredient list on the package label. (erythrosine/red dye #3) • in foods coloured with red food dye naturally in milk and because the solutions used to clean cows and milking equipment may contain iodine • in dairy products, because iodine occurs sea foods Iodine comes from many food sources. Iodine is found: Your doctor may prescribe a low iodine diet to prepare your body for radioactive iodine (RAI) treatment or scanning. A low iodine diet (LID) means that you should have foods and drinks that contain as little iodine as possible. Iodine is a mineral found naturally in many foods, especially those from the sea. In Canada, iodine is added to table salt. This is called iodized salt. • in iodized salt and foods containing iodized salt • naturally in many foods such as fish and other How can I avoid foods with iodine? What is a low iodine diet? Thyroid Cancer Canada’s Low Iodine Diet Shopping List This Shopping List includes foods allowed on the LID. Before choosing any food, read the list of ingredients. Make sure all the ingredients are allowed on the LID. The “Nutrition Facts” chart does not give you this information. In the Shopping List, brand names are printed in green letters. These product names were correct when we printed this list, but products change often. Always check the list of ingredients on the package. Make sure every ingredient is allowed on the LID. Choose Food Items From the Following List Salt, Seasonings & Condiments Non-iodized table salt (clearly labelled ‘not a source of dietary iodine’). Note: Iodine-free table salt is allowed, however, it may only be available in the USA. Sea salt is not allowed. Windsor Coarse Salt or Sifto Coarse Salt Fresh or dried herbs and pure spices Jams or Jellies – salt-free varieties Tomato/pasta sauce, tomato paste, ketchup, dry mustard, pure vinegars – salt-free varieties Honey, sugar, brown sugar Meat & Alternatives Beef, pork and/or poultry (no sauce, no brine, no seasoning) such as steak, whole chicken, etc. (if you cook it on a barbeque, be sure to scrape the grill clean first) Egg whites. When cooking or baking, separate whole eggs and use only the egg whites (almost all of the iodine is in the yolk). Or buy egg whites in a carton (Naturegg Simply Egg Whites). Chick peas, kidney beans, legumes, pintos Lentils and split peas Almonds, peanuts, cashew nuts, walnuts, hazel nuts – salt-free varieties Sunflower seeds, pumpkin seeds (pepitas) – salt-free varieties Peanut butter (or other nut butters) — salt-free (e.g. PC Blue Menu Just Peanuts Peanut Butter) Grain Products Baking supplies: flour, baking soda, baking powder, sugar, honey, maple syrup, yeast Bread: salt-free and dairy-free (e.g. Nature’s Path Manna Bread and Dimpflmeier Salt-Free Rye Bread) Crackers: salt-free varieties of Matzoh crackers, rice cakes, rice crackers, Melba Toast, tortilla wraps, Quaker Muffets, corn tortilla triangles and/or other salt-free chips Cereal whole grains: oatmeal (not individual portion size), farina, boxed grain cereal without salt (e.g. Quaker Whole Oats, Red River Cereal, Bob’s Red Mill Muesli, Post Shredded Wheat, Kellogg’s Frosted Mini Wheats) Grains: bulgur, cornmeal, couscous, rice Pasta: plain wheat or rice noodles or No Yolks pasta Vegetables & Fruits Fruit – a variety Vegetables – a variety (with the exception of frozen peas, as they are soaked in brine during processing) Dried fruits (check ingredients for salt or additives; do not purchase from a bulk-bin) Oils & Spreads Cooking & salad oil (any vegetable oil) Margarine (must be salt-free, dairy free and soy-free. Exception: Becel Vegan has salt, but the salt is non-iodized) Snacks Chips – salt-free corn chips, potato chips, tortilla chips (e.g. Miss Vickies or Kettle Brand Unsalted) Dark chocolate – salt-free, dairy-free, soy-free (e.g. Camille Bloch, Droste Bittersweet, Lindt Dark, Rapunzel Bittersweet, Schmerling) Hard candies such as Kerrs brand Marshmallows — plain, salt-free, no colour Popcorn – plain seeds for air-pop popcorn or stovetop Real fruit popsicles or sorbet (e.g. Del Monte) — milk-free and salt-free Drinks YÜ Rice Beverage — original, vanilla or chocolate (or make your own homemade nut milk or rice milk) Juice (100% juice; not fruit punch) Tea (loose or bagged) and coffee (ground, or instant freeze-dried) Pop and other unsalted carbonated drinks without red dye (no red cream soda) Lemons, limes and oranges to make lemonade, citrus drinks and tea-juice coolers Product brand names have been included solely on the basis of their LID-friendly ingredients at time of publication. Thyroid Cancer Canada did not solicit nor accept any paid endorsement of any products listed in this shopping guide. FOOD GUIDE FOR A LOW IODINE DIET Start LID on and Stop LID on Foods and ingredients to AVOID Foods and ingredients that are ALLOWED Thyroid Cancer Canada’s LID Menu Planner — Sample Menus for a Low Iodine Diet Use the Menu Planner to plan meals and snacks, along with the allowed foods on the TCC LID Shopping List. Your doctor may prescribe the LID for 2 weeks to prepare your body for radioactive iodine treatment or scanning. The LID is meant to be used for a short time. It is not recommended as healthy eating for a longer period. The Menu Planner is a general guide to provide examples of meals and snacks on a LID. For specific medical advice, check with your doctor or dietitian. The Menu Planner was correct at the time of printing, but products change often. Always check the list of ingredients on food packages. Make sure every ingredient is allowed on the LID. All of the following suggested foods are to be made with salt-free versions of packaged foods. If you add salt, be sure to use an iodine-free salt. Salt & Seasoning iodized salt (all table salt in Canada) any foods prepared with iodized salt (including any package with salt listed as an ingredient) *See information below for an exception sea salt fresh or dried herbs salt-free spices and spice mixes vinegars non-iodized salt, such as Windsor Coarse Salt or Sifto Course Salt Fish Seafood & Sea-based Food Additives Day One Breakfast Hot oatmeal or Cream of Wheat cereal with honey or brown sugar Rice milk (homemade or YÜ Rice Beverage ) Fresh fruit Coffee/ tea with lemon or rice milk (or nut milk) Dinner Salad with homemade dressing Homemade beef or vegetable stew Pop/ water/ juice Sorbet (dairy-free) Lunch Jam and peanut butter, or roasted garlic in olive oil spread on salt-free rice cakes, crackers or matzoh Homemade soup (e.g. chicken or vegetable) Fruit juice (100% juice) Snacks Fruit Marshmallows Air-popped popcorn (made from plain kernels) Popsicles (made from 100% juice) Raw veggies None all fish and shellfish all sea products such as nori, dulse, seaweed and kelp foods made with fish or seafood, such as fish sticks, sushi, maki foods with ingredients such as alginate, algin, algae, agar, carrageenan Milk & Milk Products Day Two None all dairy products such as milk, cheese, butter, yogurt foods that contain dairy products or ingredients such as whey, casein and caseinates Meat & Alternatives (No more than 2 servings of meat/poultry/beans a day - one serving of cooked meat/poultry is equal to 1/2 cup or approximately the size of the palm of your hand; one serving of beans is equal to 3/4 cup.) fresh meats or poultry prepared without salt or brine (ask the butcher how the meat was prepared) wild game any meat or poultry prepared with salt or sea salt, such as those prepared in brine cured meats such as ham, bacon, corned beef, lox, wieners and luncheon meats soybeans or soy protein products such as soy sauce, soy milk, and tofu (the exception is soy oil) egg yolks salted nuts lentils, beans and legumes egg whites unsalted nuts Breakfast Fruit smoothie (fresh fruit blended together, optionally with YÜ Rice Beverage ) Pancakes (homemade from scratch) or dry cereal Coffee/ tea with lemon or rice milk (or nut milk) Lunch Scrambled eggs made with the egg whites only and vegetable oil, fried vegetables Toast or rice crackers/matzoh crackers Fresh fruit Pop/ water/ juice/ homemade ice green tea Dinner Homemade roasted chicken (made from scratch) Roasted potatoes or rice with olive oil Steamed vegetables Or, homemade vegetable stir-fry Tropical fruits Pop/ water/ juice/coffee/tea Snacks Dark chocolate (free of milk, salt & soy) Homemade sorbet (puréed frozen fruit) Fruit Grain Products (No more than 4 servings a day. One serving = 1 slice whole-wheat bread or 1/2 cup cooked grains, cereal or pasta) breads, cereals and crackers without salt, egg yolks or dairy products unsalted pasta, rice, rice cakes, matzoh and popcorn breads, cereals or crackers made with salt, egg yolks, soya or dairy products red-coloured ready-to-eat breakfast cereals salted pasta, rice or popcorn Vegetables & Fruits fruits and “100% juice” varieties of fruit juice unsalted vegetables raisins fruit or juice with red dye #3, such as maraschino cherries or red/pink juice with artificial colour frozen peas Oils & Spreads unsalted peanut butter or nut butters vegetable oils including soy or soybean oil unsalted, dairy-free,soybean-free margarine *Becel Vegan salted peanut butter or nut butters butter or spreadable cheese products mayonnaise Day Three Breakfast Homemade muffins or toast/crackers with jam or peanut butter Fruit Coffee/ tea with lemon or rice milk (or nut milk) Lunch Salad with homemade dressing Sandwich on LID-friendly bread. Fillings may be: roasted vegetables, peanut butter & jam, homemade sliced beef or chicken. Mashed avocado can be used as substitute for mayonnaise Pop/ water/ juice Dinner Salad with homemade dressing Pasta & meat balls/meat sauce, made with store-bought or homemade tomato sauce Or, pasta with pesto sauce Homemade cake or muffins Pop/ water/ juice/ coffee/tea Snacks Homemade treats (such as oatmeal cookies, almond or coconut macaroons) Raw veggies Marshmallows Desserts & Sweets white or brown sugar, honey, maple syrup cocoa powder juice popsicles (“100% juice” varieties) jams and jellies without red dye or sea products marshmallows, hard candy, dark chocolate dairy-free sorbet desserts or sweets made with salt, egg yolks, dairy products, soymilk, tofu, salted nuts, or red dye jams or jellies with red dye or sea products milk chocolate Drinks coffee or tea without milk or cream homemade nutmilk and/or Yü Rice beverage (rice milk) ”100% juice” varieties of fruit juice fruit smoothies made without dairy or soy products beer, wine and spirits if allowed by your doctor soft drinks (pop) without red dye coconut milk (salt free variety) milk, cream or drinks made with dairy products soy milk punch, fruit cocktail and other drinks coloured with red dye powdered drinks soft drinks (pop) with red dye (e.g. red soda pop) Supplements & Other all restaurant and take-out food, including black coffee red dye #3 or erythrosine, used in red/pink foods, drinks and medications (e.g. some cough medicine) medications or vitamins that contain salt or milk supplements with iodine or ingredients from the sea, such as kelp, glucosamine, chondroitin, selenium, coral or oyster shell calcium some medications for cardiac arrhythmia such as Amidarone skin creams or antiseptics made with iodine such as betadine medications, vitamins and supplements without salt, milk, sea ingredients, iodine or red dye #3 (check with your pharmacist) * Becel Vegan margarine does list salt as an ingredient, but the company asserts that the salt is non-iodized. Thyroid Cancer Canada’s recipes available at www.thyroidcancercanada.org The Low Iodine Diet Cookbook, by Norene Gilletz, is available both in hard copy and as an e-book at www.yourhealthpress.com/ Note: recipes on American websites, list iodine-free salt in many recipes as it is readily available in the USA. If iodine-free salt is not available to you, omit salt from the recipe. This information was prepared for general educational purposes only. It is not intended as specific medical advice or direction. The information was current at the time of printing, however we encourage you to always check labels for appropriate ingredients. For information about serving sizes, see Canada’s Food Guide. www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php For more information about the low iodine diet, speak to a member of your healthcare team. © Thyroid Cancer Canada We reserve the right to copy and distribute. For more information: [email protected] Do not stop taking any medications without talking to your doctor All radiographic contrast media contain iodine. Thus, if you have had a CT/CAT scan with contrast, it may delay having a RAI scan or treatment by at least four months, due to the iodine content of the contrast. Consult with your doctor for specific medical advice. Version 6 – Aug 2013 Thyroid Cancer Canada